Thrombophlebitis is an inflammation of the vein wall with the formation of a blood clot in its lumen.
Etiology and pathogenesis . Observed as a complication of some infectious diseases (influenza, typhus and typhoid fever, dysentery, erysipelas), after childbirth and abortion, with purulent inflammatory processes ( phlegmon , carbuncle, osteomyelitis, etc.), as well as varicose veins (see) lower limbs.
An important condition for the formation of a blood clot in the lumen of a vein is an inflammatory lesion of its inner wall ( endothelium ) due to infection of the vein directly from the surrounding tissue or hematogenous.
The formation of a blood clot contributes to the slowing down of blood flow in the veins, their varicose dilation, compression by a tumor, damage to the veins during operations, injuries. After puncture of the vein, as well as long-term presence of a needle or cannula in its lumen with intravenous infusions, puncture thrombophlebitis may occur. When a vein is involved in the inflammatory process from a nearby pathological focus, changes develop primarily on its outer wall (periphlebitis); When blood is transported by bacteria and settled in a vein, the inflammatory process begins with the inner wall (endoflebitis). In either case, inflammation of the entire venous wall occurs (see Phlebitis ), a thrombus forms in the lumen (see Thrombosis ).
Thrombophlebitis can develop in any part of the body: in the cerebral veins during purulent processes on the face (carbuncle) or in the middle ear ( otitis ), in the portal vein with purulent appendicitis or cholecystitis (see Pyleflebitis ), in the pelvic veins after operations on small organs pelvis. More often thrombophlebitis occurs in the veins of the lower extremities and proceeds in acute, subacute and chronic forms. Both deep and superficial veins are affected.
The clinical picture, the diagnosis. According to the clinical course, there are several forms of thrombophlebitis of the lower extremities.
Acute deep vein thrombophlebitis begins suddenly with pain in the affected limb, chills, high fever (up to 38 ° –39 °). Feeling of the limb along the affected vein is sharply painful. By the end of the first day, the sore limb dramatically swells, the skin on it becomes tense, pale, shiny, colder than healthy; pulse dramatically weakened or not detected at all (spasm of arteries). The inguinal lymph nodes are enlarged, painful. In the coming days, skin collaterals (circumferential pathways), which are a network of veins protruding under the skin on the inner surface of the thigh and lower leg, will expand. The outflow of blood through them is improving slowly, and the swelling of the limb lasts for 2-3 months. There is an increased amount of leukocytes in the blood (up to 10,000–15,000), an accelerated ESR , an increased content of fibrinogen (up to 410–850 mg%), and prothrombin up to 150–155%.
After subsiding of the acute phenomena of the disease, the so-called post-phlebitic syndrome often develops.
Acute thrombophlebitis of the superficial veins also begins suddenly. The process is often localized in the system of the great saphenous vein, which is palpable in the form of a dense, painful cord with reddened over it and swollen skin. A moderate swelling of the diseased limb gradually develops, the skin acquires a bluish tint. The temperature at the beginning of the disease is about 38 °, then gradually decreases to normal numbers.Go
Acute thrombophlebitis of the superficial veins can turn into purulent with the melting of the vein and the clot in it, with the formation of abscesses around the vein and often spreading them along the affected vessel (ascending thrombophlebitis).
Subcutaneous and chronic thrombophlebitis that were previously isolated are currently considered as chronic venous insufficiency of the lower extremities or post-phlebitic syndrome. Its essence lies in the fact that as a result of deep venous thrombophlebitis transferred and the subsequent recanalization of a blood clot (formation of channels in it), the valves of the deep veins and veins connecting the deep and superficial venous system are destroyed. As a result, the outflow of blood from the lower extremities is disturbed. The disease is manifested by dull pain and swelling of the legs, aggravated by the end of the day or after prolonged standing (swollen painful form), or varicose dilatation of the superficial veins and the development of trophic changes in the skin of the lower third of the legs, or the development of varicose ulcers (varicose ulcers).
Migrating (wandering) thrombophlebitis affects the superficial veins of the limbs, often the lower. In the course of the veins suddenly appear small painful seal, indicating the formation of blood clots.
The skin above them swells, reddens. First there is one, then several nodules along the same vein (usually higher in the blood flow), they can occur simultaneously in several veins. The affected vein is palpable in the form of a bundle with tight knots. The resulting nodule lasts for several days and gradually resolves. The general condition of patients varies little, the temperature in most cases is normal. Mainly young men are ill. The disease runs chronically for many months and even years, occasionally escalating. Observed with tuberculosis, rheumatic lesions, often combined with endarteritis (see) or precedes it.